HEALTH CARE SERVICES EVALUATOR/NURSE
To land Health Care Services Evaluator/Nurse in New Jersey you go through the competitive route: you sit an announced exam and the score puts you on the eligible list agencies hire from.
A bachelor's degree is the listed credential, and extra years on the job can be traded for it, and a professional license is required on top of that. The FY 2027 range lands between $79,844 and $117,228, and state payroll currently lists about 82 people in the title, most of them at Health and Senior Services.
How to apply
This title is filled by competitive examination.
See every real route in, and where to apply. 2 agencies employ it. We don't track live vacancies.
See all 2 employers and how to apply →Who employs this title
Health Care Services Evaluator/Nurse appears on the State payroll at 2 departments, most of them at Department of Health.
State departments
| Employer | Employees |
|---|---|
| Department of Health | 80 |
| Department of Banking & Insurance | 2 |
State payroll and independent authority payroll are separate systems and are never merged. See data sources.
Who employs this title
State payroll records show 82 people working under this title. The median actual salary is $102,428. The agencies employing the most are:
- Health and Senior Services (80)
- Banking and Insurance (2)
Counts from NJ YourMoney agency payroll. See statewide workforce analytics.
Official job specification
The text below is the official specification published by the New Jersey Civil Service Commission. The plain-language summary and analysis above are derived from it by NJ Civil Service Navigator. Source: the official specification page at NJ CSC.
Definition
Under direction of a supervisory officer inspects, monitors, and evaluates, investigates complaints and determines appropriate levels of care for community-based and/or institutionalized patients to evaluate the delivery of essential health care needs and quality of service provided to eligible recipients; does other related duties.
Examples of work
Participates in the inspection and survey of Health Care Facilities to determine compliance with Federal Titles XVII and/or XIX for Medicare certification and/or state licensure, including laws, codes, statutes and regulations. Confers with health care providers to maintain and/or improve the quality of care and life for residents or patients of licensed and/or certified health care facilities. Provides technical assistance to health care providers and other interested parties in the application and interpretation of regulations for state licensure and federal certification. Reviews and analyzes the patient/resident comprehensive multi- disciplinary care plans to identify the need for long term care; evaluates the scope of service delivery. Assesses clients through observation, interview and medical record verification, and other characteristics, and authorizes placement in institutional or community based settings. Provides information and counsel to clients and their families regarding community health resources and alternatives to long term care facilities. Monitors the receipt of Correction Plans from providers of Health Care Facilities. Reviews and monitors the quality of services provided to recipients in licensed and/or health care facilities. Visits and inspects health care facilities. Audits medical records for appropriate utilization of services and accuracy of claims reporting; reports suspicious medical records to appropriate federal or state agency if fraud or abuse is suspected. Completes in-depth clinical assessment forms. Monitors and evaluates the quality of services in meeting clients' needs according to federal, state, local and other rules and regulations. Establishes and maintains cooperative working relationships with health-related associates, organizations, agencies and others. Prepares and conducts training on health related issues. Recommends official sanctions and curtailment activities based on evaluation of facility's non-compliance. Investigates complaints, identifies deficiencies in patient care, possible abuse, safety or other health hazards in according to state and federal health requirements. Promotes health and safety of patients and/or residents by identifying, evaluating, and determining ancillary health care services and equipment, according to state licensing and/or federal Medicare regulations. Monitors and assesses the utilization review plan and organization in state and county psychiatric hospitals and residential treatment centers for compliance with provisions of Medicare and Medicaid. Conducts individual quarterly utilization reviews; recommends alternative placement when appropriate. Participates in managed care plan site visits and prepares reports containing findings. Investigates and resolves complaints concerning health maintenance organizations (HMOs) and other managed care organizations; identifies violations and provides recommendations for corrective action. Aids consumers and providers in the utilization management appeals process. Provides technical assistance to consumers, providers and HMOs in the application and interpretation of the HMO regulations, the Health Care Quality Act and other applicable rules and laws concerning HMOs and other managed care organizations. Completes detailed licensure and/or certification survey report forms. Visits health care facilities, to monitor and evaluate the delivery of health care to monitor compliance with state and federal laws and regulations. Conducts multi-disciplinary exit conferences. Participates in a medical review team, provides nursing consultation regarding a client's clinical status and provider's efficiency. Provides testimony in Administrative Law hearings. Participates in divisional inter-disciplinary meetings to solve problems, present suggestions, and to exchange professional material. Reviews and evaluates plans submitted by health care providers. Prepares correspondence. May review proposed standards for health care facilities and develop recommendations. Performs other health care services for various client populations which may include the developmentally and physically impaired, children, geriatric and others. Will be required to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.
License
Applicants must possess a current license as a professional Registered Nurse in the State of New Jersey. Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform the essential duties of the position.
Knowledge, skills and abilities
Knowledge of health care concepts. Knowledge of the methods used to inspect health care facilities. Knowledge of the nursing principles. Knowledge of the methods used to assess client health care needs. Knowledge of methods used to obtain and compile health information. Knowledge of social and economic health needs and resources in the State of New Jersey after a period of training. Knowledge of the methods used to evaluate medical review policies and procedures. Knowledge of the methods used to review and audit medical records. Knowledge of the methods used to investigate and evaluate complaints. Ability to read, interpret and apply federal regulations as they relate to the Medicare/Medicaid program and the certification of long term care facilities, home health agencies, hospices, end state renal disease centers, ambulatory surgical centers, and others, as appropriate. Ability to read, interpret and apply New Jersey Health Maintenance Organization (HMO) statues and regulations, Selective Contracting Arrangements (SCA) Regulations, Workers Compensation Managed Care Organization (W. C. MCO) regulations, the Health Care Quality Act and other applicable laws and rules regarding managed care organizations Ability to assess and evaluate client health care needs. Ability to evaluate the quality of service of health provider programs. Ability to establish and maintain cooperative working relationships with other health associates. Ability to provide testimony at hearings. Ability to prepare reports containing findings, conclusions, and recommendations. Ability to prepare correspondence. Ability to establish and maintain records and files. Ability to conduct investigations, and evaluate complaints. Ability to provide technical assistance and advice. Ability to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units. Ability to read, write, speak, understand, and communicate in English sufficiently to perform the duties of this position. American Sign Language or Braille may also be considered as acceptable forms of communication. Persons with mental or physical disabilities are eligible as long as they can perform the essential functions of the job after reasonable accommodation is made to their known limitations. If the accommodation cannot be made because it would cause the employer undue hardship, such persons may not be eligible. CODES: 23/P25 - MCK 04/23/07
Note
The examples of work for this title are for illustrative purposes only. A particular position using this title may not perform all duties listed in this job specification. Conversely, all duties performed on the job may not be listed. Applicants must meet one of the following or a combination of both experience and education. Thirty (30) semester hour credits are equal to one (1) year of relevant experience. Seven (7) years of professional experience as a professional Registered Nurse; which shall have included one or more of the following: clinical nursing, practice in nursing supervision, nursing management, or public health nursing; or seven (7) years of professional experience in the evaluating or rating of licensed and/or certified health care facilities or managed health care plans to determine compliance with state licensure and Medicare and Medicaid standards. OR Possession of a bachelor's degree from an accredited college or university and three (3) years of the above-mentioned professional experience. "Professional experience" refers to work that is creative, analytical, evaluative, and interpretive; requires a range and depth of specialized knowledge of the profession's principles, concepts, theories, and practices; and is performed with the authority to act according to one's own judgment and make accurate and informed decisions. Applicants who have graduated from an accredited school of nursing or possess an associate degree in nursing may substitute two (2) years of additional professional experience on a year-for- year basis for the required bachelor's degree. Appointees will be required to successfully complete the Basic Surveyor Training and pass the Surveyor Minimum Qualifying Test. The training will be provided at the onset of employment.